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Geneva, Switzerland, World Health Organization [WHO], 2018. 458 p.Girls and women who have been subjected to female genital mutilation (FGM) need high quality, empathetic and appropriate health care to meet their specific needs. This handbook is for health care providers involved in the care of girls and women who have been subjected to any form of FGM. This includes obstetricians and gynaecologists, surgeons, general medical practitioners, midwives, nurses and other country-specific health professionals. Health-care professionals providing mental health care, and educational and psychosocial support – such as psychiatrists, psychologists, social workers and health educators – will also find this handbook helpful. It includes advice on how to: 1) communicate effectively and sensitively with girls and women who have developed health complications due to FGM; 2) communicate effectively and sensitively with the husbands or partners and family members of those affected; 3) provide quality health care to girls and women who have health problems due to FGM, including immediate and short-term urogynaecological or obstetric complications; 4) provide support to women who have mental health and sexual health complications caused by FGM; 5) make informed decisions on how and when to perform deinfibulation; 6) identify when and where to refer patients who need additional support and care; and 7) work with patients and families to prevent the practice of FGM.
[Geneva, Switzerland], WHO, 2016 Feb.  p.This fact sheet on Zika virus contains a list of key facts and information on its signs and symptoms, potential complications, transmission, diagnosis, prevention, treatment, and WHO response.
OS032. Pharmacotherapy for pre-eclampsia in low and middle income countries: An analysis of essential medicines lists (EMLS).
Pregnancy Hypertension. 2012 Jul; 2(3):193-4.INTRODUCTION: Pre-eclampsia is the second leading cause of maternal mortality in low and middle income countries (LMIC). Pharmacological management of pre-eclampsia has five major components including antihypertensive therapy for severe and non-severe hypertension, magnesium sulphate for prevention or treatment of eclampsia, treatment of pre-eclampsia-related end-organ complications, antenatal corticosteroids for acceleration of fetal pulmonary maturity given iatrogenic preterm delivery for maternal and/or fetal indications, and labour induction for such indicated deliveries. Essential medicines are defined by the World Health Organization (WHO) as "drugs that satisfy the health care needs of the majority of the population". Essential Medicines Lists (EMLs) detail these essential medicines within an individual country and support the argument that the medication should be routinely available. OBJECTIVES: To determine how many drugs required for comprehensive pre-eclampsia management are listed in national EMLs of LMIC. METHODS: We conducted a descriptive analysis of relevant drug prevalence on identified EMLs. We searched for the national EMLs of the 144 LMIC identified by the World Bank. EMLs were collected by broad based internet searches and in collaboration with the WHO. The EMLs were surveyed for therapies for the different aspects of pre-eclampsia management: hypertension (non-severe and severe with oral or parenteral agents), eclampsia, pre-eclampsia complications (e.g., pulmonary oedema, thrombosis), preterm birth, and labour induction. RESULTS: EMLs were located and reviewed for 58(40.3%) of LMIC. One or more parenteral antihypertensive agents were listed in 51(87.9%) EMLs. The most common agents were: hydralazine (67.2%), verapamil (58.6%), propranolol (39.7%) and sodium nitroprusside (37.9%); parenteral labetalol was listed by only 19.0% of EMLs. The most prevalent oral antihypertensive therapies listed were: nifedipine (96.6%, usually 10 or 20mg intermediate-acting tablets), methyldopa (94.8%), propranolol (89.7%), and atenolol (87.9%). Captopril, enalapril, hydrochlorothiazide and spironolactone were commonly listed. Magnesium sulphate for prevention and management of eclampsia was present in 86.2% of EMLs (and its antidote, calcium gluconate in 82.8%). To manage complications of pre-eclampsia, oral frusemide was listed in 94.8% of EMLs and parenteral heparin in 91.4%. Most EMLs listed parenteral dexamethasone (91.4%) for acceleration of fetal pulmonary maturity and oxytocin (98.3%) or a prostanoid (usually misoprostol, 39.7%) for labour induction. CONCLUSION: EMLs of LMIC provide comprehensive coverage of all aspects of recommended pre-eclampsia pharmacotherapy. These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country. Copyright (c) 2012. Published by Elsevier B.V.
Bulletin of the World Health Organization. 2012 Sep 1; 90(9):712.The World Health Organization’s (WHO) update of its 2003 publication Safe abortion: technical and policy guidance for health systems has responded to a major neglected public health need of women. The substantial revisions in the 2012 update reflect developments in safe abortion methods and clinical care, providing guidance about the range of safe options available to women seeking elective abortion. Women’s participation in the choice of abortion method, pain control and post-abortion contraception is a crucial element, seeing as unsafe induced abortion is not only public health problem but also a human rights issue. The report discusses developments in the application of human rights principles in policy-making and in legislation related to induced abortion. National courts and regional and international human rights bodies, such as the United Nations treaty monitoring bodies, have increasingly applied these principles to facilitate women’s transparent access to safe abortion services.
Geneva, Switzerland, WHO, 2011.  p.The primary goal of the present guidelines is to improve the quality of care and outcomes for pregnant women undergoing induction of labour in under-resourced settings. The target audience of these guidelines includes obstetricians, midwives, general medical practitioners, health-care managers and public health policy-makers. The guidance provided is evidence-based and covers selected topics related to induction of labour that were regarded as critical priority questions by an international, multidisciplinary group of health-care workers, consumers and other stakeholders.
African Journal of Reproductive Health. 2008 Apr; 12(1):7-11.Add to my documents.
Eliminating female genital mutilation: an interagency statement. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO.
Geneva, Switzerland, World Health Organization [WHO], 2008. 41 p.The term 'female genital mutilation' (also called 'female genital cutting' and 'female genital mutilation/cutting') refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Between 100 and 140 million girls and women in the world are estimated to have undergone such procedures, and 3 million girls are estimated to be at risk of undergoing the procedures every year. Female genital mutilation has been reported to occur in all parts of the world, but it is most prevalent in: the western, eastern, and north-eastern regions of Africa, some countries in Asia and the Middle East and among certain immigrant communities in North America and Europe. Female genital mutilation has no known health benefits. On the contrary, it is known to be harmful to girls and women in many ways. First and foremost, it is painful and traumatic. The removal of or damage to healthy, normal genital tissue interferes with the natural functioning of the body and causes several immediate and long-term health consequences. For example, babies born to women who have undergone female genital mutilation suffer a higher rate of neonatal death compared with babies born to women who have not undergone the procedure. (excerpt)
[New York, New York], UNICEF, .  p.Female Genital Mutilation (FGM) is defined as procedures involving partial or total removal of female genitals or other injury to female genital organs. In Somalia, FGM prevalence is about 95 percent and is primarily performed on girls aged 4-11. FGM can have severely adverse effects on the physical, mental, and psycholsocial well being of those who undergo the practice. The health consequences of FGM are both immediate and life-long. Despite the many internationally recognized laws against FGM, lack of validation is Islam and global advocacy to eradicate the practice, it remains embedded in Somali culture. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006.  p. (WHO/HTM/TB/2006.361)The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective global TB control. In many other countries, the extent of drug resistance is unknown and the management of patients with MDR-TB is inadequate. In countries where drug resistance has been identified, specific measures need to be taken within TB control programmes to address the problem through appropriate management of patients and adoption of strategies to prevent the propagation and dissemination of drug-resistant TB, including MDR-TB. These guidelines offer updated recommendations for TB control programmes and medical workers in middle- and low-income countries faced with drug-resistant forms of TB, especially MDR-TB. They replace two previous publications by the World Health Organization (WHO) on drug-resistant TB. Taking account of important developments in recent years, the new guidelines aim to disseminate consistent, up-to-date recommendations for national TB control programmes and medical practitioners on the diagnosis and management of drug-resistant TB in a variety of geographical, political, economic and social settings. The guidelines can be adapted to suit diverse local circumstances because they are structured around a flexible framework approach, combining a consistent core of principles and requirements with various alternatives that can be tailored to the specific local situation. (excerpt)
Are a past history of tuberculosis and WHO clinical stage associated with incident tuberculosis in adults receiving antiretroviral therapy? [letter [reply]
AIDS. 2007 Jan; 21(3):389-390.In two recent excellent articles, Lawn and colleagues [1,2] reported the incidence and risk factors for active tuberculosis among HIV-infected adults receiving antiretroviral therapy (ART) in South Africa. In both studies, they found contradictory results regarding the association between the baseline World Health Organization (WHO) clinical stage and the occurrence of incident tuberculosis during follow-up, and contradictory trends towards an association between a past history of tuberculosis at enrolment and a lower (first study) or higher (second study) incidence of tuberculosis during follow-up. (excerpt)
Past history of tuberculosis is not a risk factor for incident tuberculosis during antiretroviral treatment in South Africa [letter] [reply]
AIDS. 2007 Jan 30; 21(3):388-389.We thank Ouattara and colleagues for their letter concerning risk factors for incident tuberculosis during antiretroviral treatment (ART) in sub-Saharan Africa. In a study from Abidjan that included 12 cases, Seyler et al. identified a past history of tuberculosis as the sole risk factor for incident tuberculosis. We reported a larger number of cases (n = 27) within a hospital-based study cohort in Cape Town and, in contrast, a low baseline CD4 cell count and advanced World Health Organization (WHO) stage of disease were the principal risk factors. In a second, much larger community-based study, we found that the current CD4 cell count was the sole independent risk factor for incident tuberculosis (n = 81). In both our studies, a history of previous tuberculosis was consistently found not to be a significant risk factor, agreeing with other unpublished studies from South Africa, Uganda and Senegal; a further study from Uganda reported a strong but statistically nonsignificant trend towards an association. (excerpt)
Lancet. 2006 Jun 3; 367(9525):1799-1800.In today's Lancet, the WHO study group report a multicentre prospective study of the obstetric outcome in women who have had genital mutilation. Their study strengthens the evidence base about complications of such mutilation. For a subject with many important confounding factors, we congratulate the researchers for the study design and tenacity in execution. The finding of a causal relation between complications and type of mutilation indicates that the more brutal the type of procedure, the worse the complication. Yet, as has been advocated, there can be no justification for even excision of the prepuce in type I female genital mutilation. Advocating mild forms of cutting can raise the possibility of a dubious refocusing to appease cultural sensitivity sentiments. (excerpt)
Rapid spread of TB, AIDS discussed by World Health Assembly - includes brief updates on health improvement developments - United Nations developments.
UN Chronicle. 1993 Sep; 30(3): p..The rapid worldwide spread of diseases, such as tuberculosis (TB) and acquired immune deficiency syndrome (AIDS) was a focus of discussions at the forty-sixth World Health Assembly (Geneva, 3-14 May). Plans of the World Health Organization (WHO) to fight health scourges, old and new, were outlined in resolutions adopted by the Assembly. A new Global Strategy for Health and Environment, an outcome of "Agenda 21" - the action programme adopted at the 1992 Earth Summit in Rio de Janeiro - was endorsed. It warned that sustainable development was possible only when special attention was given to health and environment-related matters. WHO was asked to carry out prospective studies on potential environmental hazards to human health. (excerpt)
Drug Safety. 2005; 28(4):277-286.Artemisinin combination therapies (ACTs) have been recommended for the treatment of malaria in countries where there is widespread resistance to commonly used antimalarial drugs. Several sub-Saharan African countries are, therefore, in the process of introducing ACTs in their malaria drug policies. However, there is limited information about the safety of ACTs outside South East Asia, where their use has been well documented. As with all other new medicinal compounds, the monitoring of a drug's safety or ’pharmacovigilance’ is important, especially in areas where co-morbid conditions, such as HIV/AIDS, malnutrition and tuberculosis, are common. Because in most malaria endemic countries, particularly Africa, there are no pharmacovigilance programmes in place, it has been suggested that the introduction of ACTs offers an opportunity for these countries to put drug safety monitoring systems in place. Backed by the WHO Roll Back Malaria department and other international cooperating partners, five African countries, which are in the process of introducing ACTs (Burundi, Democratic Republic of the Congo, Mozambique, Zambia and Zanzibar), have drawn up action plans to introduce pharmacovigilance in their health sector. It is planned that once the safety monitoring of antimalarials has been established, these activities can then be extended to cover medicinal compounds used in other public health programmes, such as HIV/ALDS, tuberculosis and the immunisation programmes. This article looks at the rationale for pharmacovigilance, the process of setting up monitoring centres and the challenges of implementing the project in the region. (author's)
Current Opinion in Obstetrics and Gynecology. 2005; 17:490-494.The purpose of this review is to aid the healthcare practitioner in caring for children, girls, and women who have undergone female genital mutilation or who are at risk for female genital mutilation. The bulk of the literature published in the area of female genital mutilation over the past year addresses the laws, social needs, immigration status and assimilation of African women who immigrate into western countries. Clinicians continue to publish case reports of complications and the surgical management of type III female genital mutilation during labor. Additionally, as people continue to try to eliminate female genital mutilation through human rights campaigns and the legal system, they have also become increasingly aware that understanding the motives behind this traditional practice may be an avenue towards change. The fundamental understanding of female genital mutilation will allow the clinician to address the emotional and physical needs of the children, girls, and women who have undergone this traditional practice or who are at risk for undergoing this practice. This understanding will allow the practitioner to individualize the history and physical examination, and to provide appropriate management with recognition and treatment of complications. Increased knowledge of the laws against female genital mutilation will allow the healthcare provider to educate and advise at-risk girls and women as well as their parents. (author's)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 2004. 44 p.This framework, which draws on the Global strategic framework to reduce the burden of TB/HIV and on the Guidelines for phased implementation of collaborative TB and HIV activities, was developed based on the following two premises. First, the National TB Programme (NTP) needs to address the impact of HIV, i.e. higher caseload of TB and increasing drug-resistant TB, and to mobilize resources related to TB/HIV activities. Second, the National AIDS Programme (NAP) needs to prolong the life and reduce the suffering of PHA through better management of TB, and to mobilize resources for TB/HIV. The Regional framework is built on the strengths of the individual National TB and AIDS Programmes, and identifies areas in which both programmes complement each other in addressing TB/HIV. This approach is considered useful, not only for countries with a relatively high prevalence of HIV, such as Cambodia, but also for most of countries in the Region that are faced with a relatively low prevalence of HIV. The scope of the Regional framework comprises interventions against tuberculosis (intensified case- finding and cure and tuberculosis preventive treatment) and interventions against HIV (and therefore indirectly against tuberculosis), e.g. comprehensive prevention, care and support, including condoms, sexually transmitted infection (STI) treatment, safe injecting drug use (IDU) and antiretroviral (ARV) treatment. Key components of the Regional framework are: surveillance; diagnosis and referral, including voluntary counselling and testing (VCT) for HIV; interventions; and, areas of collaboration. The framework outlines the roles of the individual TB and HIV/AIDS programmes (i.e. “who does what”) and provides examples of how to operationalize the different components. (excerpt)
Geneva, Switzerland, WHO, 2005.  p. (Integrating STI / RTI Care for Reproductive Health; USAID Development Experience Clearinghouse DocID / Order No: PN-ADC-591)This Guide is intended to be a reference manual, and a resource to educate and to remind health care workers of the need to consider STIs/RTIs when providing other reproductive health services. It recommends prevention and care practices for patients who have or may be at risk of acquiring a reproductive tract infection. As such, it could be used for preservice or in-service health provider education and training, as a source of up-to-date, evidence-based recommendations, and as a selfeducation tool for health care providers on the prevention, treatment, and diagnosis of RTIs. Programme managers can use it as a starting-point for improving policies, programmes and training on the prevention and management of STI/RTI, adapting the information and recommendations as needed to local conditions. The information is grouped according to “reasons for visit”. Providers are encouraged to consider the possibility of STI/RTI, educate and counsel clients about prevention, and offer necessary treatment. Providers can use the Guide as a whole, or focus on the sections that are relevant to their daily practice. (excerpt)
Brazzaville, Congo, WHO, Regional Office for Africa, .  p.This document presents statistics illustrating the magnitude, causes, and consequences of maternal mortality in the World Health Organization African region. Challenges and obstacles in reducing these mortality rates are also discussed, as are current plans to improve maternal health including community participation, improvement in emergency obstetric care and additional training for health professionals.
Variation in incidence of serious adverse events after onchocerciasis treatment with ivermectin in areas of Cameroon co-endemic for loiasis.
Tropical Medicine and International Health. 2003 Sep; 8(9):820-831.Objective: To determine the incidence of serious adverse events (SAEs) after mass treatment with ivermectin in areas co-endemic for loiasis and onchocerciasis, and to identify potential risk factors associated with the development of these SAEs, in particular encephalopathic SAEs. Methods: We retrospectively analysed SAEs reported to have occurred between 1 December 1998 and 30 November 1999 in central-southern Cameroon by chart review, interview and examination of a subset of patients. Results: The overall incidence of SAEs for the three provinces studied was 6 per 100,000. However, for Central Province alone the incidence of SAEs was 2.7 per 10,000 overall, and 1.9 per 10,000 for encephalopathic SAEs associated with Loa loa microfilaremia (PLERM). The corresponding rates for the most severely affected district within Central Province (Okola) were 10.5 per 10,000 and 9.2 per 10,000 respectively. Symptoms began within the first 24–48 h of ivermectin administration but there was a delay of approximately 48–84 h in seeking help after the onset of symptoms. First-time exposure to ivermectin was associated with development of PLERM. Conclusion: In Cameroon, the incidence of SAEs following ivermectin administration in general, and PLERM cases in particular, varies substantially by district within the areas co-endemic for loiasis and onchocerciasis. More intense surveillance and monitoring in the first 2 days after mass distribution in ivermectin-naïve populations would assist in early recognition, referral and management of these cases. The increased reporting of SAEs from Okola is unexpected and warrants further investigation. Research is urgently needed to find a reliable screening tool to exclude individuals (rather than communities) at risk of PLERM from the mass treatment program. (author's)
Journal of Health and Population in Developing Countries. 2003 Jul 2;  p..The trend and predictors of infertility are not well known in sub-Saharan Africa. A nationally representative Demographic and Health Survey (TDHS) was conducted in Tanzania in 1991/92, 1996 and 1999, enabling a trend study of infertility. Logistic regression was used to determine the predictors of infertility. The prevalence of primary infertility was about 2.5%, and secondary infertility was about 18%. There was no change between the 1991/92, 1996 and 1999 TDHS. The risk of primary infertility was higher in the Dar es Salaam and Coast regions than in other regions and secondary infertility was higher in the Dar es Salaam region. The Dar es Salaam and Coast regions are known for also having elevated levels of HIV/AIDS. Because sexual practices and sexually transmitted diseases are strong predictors of pathological infertility and HIV infection in Africa, we recommend that concerted efforts be made to integrate the prevention of new incidences of infertility with the HIV/AIDS campaigns. (author's)
Living well with HIV / AIDS: a manual on nutritional care and support for people living with HIV / AIDS.
Rome, Italy, FAO, 2002. vi, 97 p.The links between nutrition and infection are well known. Good nutrition is essential for achieving and preserving health while helping the body to protect itself from infections. Consumption of a well-balanced diet is essential to make up for the loss of energy and nutrients caused by infections. Good nutrition also helps to promote a sense of well-being and to strengthen the resolve of the sick to get better. The nutritional advice in this manual can help sick people, including those living with HIV/AIDS, to feel better. Few crises have affected human health and threatened national, social and economic progress in quite the way that HIV/AIDS has. The pandemic has had a devastating impact on household food security and nutrition through its effects on the availability and stability of food, and access to food and its use for good nutrition. Agricultural production and employment are severely affected and health and social services put under great strain. Families lose their ability to work and to produce. With worsening poverty, families also lose their ability to acquire food and to meet other basic needs. Time and household resources are consumed in an effort to care for sick family members, partners may become infected, families may be discriminated against and become socially marginalized, children may be orphaned and the elderly left to cope as best they can. Meeting immediate food, nutrition and other basic needs is essential if HIV/AIDS-affected households are to live with dignity and security. Providing nutritional care and support for people living with HIV/AIDS is an important part of caring at all stages of the disease. This manual provides home care agents and local service providers with practical recommendations for a healthy and well-balanced diet for people living with HIV/AIDS. It deals with common complications that people living with HIV/AIDS experience at different stages of infection and helps provide local solutions that emphasize using local food resources and home-based care and support. (excerpt)
Lancet. 2003 Jul 19; 362(9379):249.These positive results from the new community-based therapeutic care (CTC) model of intervention call for a change in the way that we classify acute malnutrition. The WHO classification consists of moderate and severe categories, defined according to anthropometry and the presence of bilateral pitting oedema. This classification was appropriate and operationally relevant when the modes of treatment involved inpatient therapeutic feeding centres for severe acute malnutrition, and outpatient supplementary feeding for moderate acute malnutrition. This new era of community-based care, however, has three treatment modes. To be operationally relevant, a new system of classification must, therefore, include complicated malnutrition as well as severe and moderate malnutrition. (excerpt)
[Bangkok, Thailand], United Nations Development Programme [UNDP], South-East Asia HIV and Development Project, 2001 Feb.  p.This prompted me to wonder about the following two sides of the same consideration below: 1. Whether development decision makers and experts could explore how Communication could help them promote policies and activities on the interrelations between HIV/AIDS and development; and 2. Whether Communication experts could try to apply their talents to these complex but important interrelations. This is why, besides contributing to the Drum Beat chat, I would like to draw the attention of those interested in the relationship between HIV/AIDS and development to the potential role Communication could play. In other words, as HIV/AIDS is increasingly being recognized as a multisectoral issue, I would like to advocate for the need to develop appropriate Communication strategies for the development sectors (e.g. transport, construction, agriculture) most relevant for combating HIV/AIDS, besides the health one. (excerpt)
Geneva, World Health Organization, 1966. (Technical Report Series NO. 332).The value and possible hazards of IUDs are discussed. Grafenberg developed a metal ring IUD in 1928. There was initial enthusiasm about the device, but it became discredited and interest was not revived in the method until 1959. Today, various shapes, sizes, and materials are employed in making IUD'S. No single cause or mechanism of action of an IUD has so far come to light. In sub-human primates the IUD causes accelerated passage of ova through the tube and the rest of the reproductive tract appears to be the major, but not necessarily the only, mechanism, of action. In ruminants, the contraceptive action of the IUD is exerted, at least in part, at the ovarian level. In rats, mice, rabbits, and ferrets, the main effect of the IUD is suppression of the implantation. It is concluded that the action of the IUDs in the human species is exerted before the stage of implantation. The most effective devices are associated with an incidence of 1.8 to 2.9 pregnancies per 100 insertions during the first year of use. The frequency of spontaneous expulsion ranges from about 5% to over 20% depending on the type of device. About one half of all expulsions occur in the first 3 months and comparatively few after the first year. The incidence of removal for medical reasons ranges from approximately 10% to 25% of first insertions during the first year. The method can be used successfully by almost 3 out of every 4 women who adopt it. Side effect and complications include bleeding and pain and less frequently pelvic inflammatory disease and perforation. The only absolute contraindications to the use of IUDs are: (1) active pelvic inflammatory disease, and (2) pregnancy, proven or suspected. Research needs are noted.
REAL LIVES. 2001 Feb; (6):41-2.Although abortion is illegal in many developing countries, this has not prevented the procedure from occurring. It is well known that women faced with unwanted pregnancies resort to abortion regardless of the legality and the risks associated with the procedure. Many have no choice but to undergo abortions performed by unqualified people in unhygienic settings. High rates of maternal morbidity and mortality prevail in many countries. This article is a doctor's argument that by legalizing or liberalizing restrictive abortion laws, and investing in safe abortion services, governments can save the lives of thousands of women each year. Legalizing abortion does not increase demand for the procedure, rather, it decreases the rate of abortion-related deaths. The International Planned Parenthood Federation (IPPF) has consistently supported efforts to legalize abortion, and many of its publications have indicated its political support for this cause. Hence, family planning associations should be guided by the IPPF's principles of advocating for the legalization of abortion. They should design advocacy programs aimed at both reforming the laws and policies to support women's rights and improving access to family planning and abortion related services.